Ankle Pain Still Tops for Patients With Hemophilia in Germany


Outside of the ankle, knees and elbows were also commonly affected joints for patients with hemophilia.

Ankle Pain Still Tops for Patients With Hemophilia in Germany

Jamil Hmida

Despite new therapies, patients with hemophilia continue to suffer from joint pain, particularly in the ankles, knees, and elbows.

A team, led by Jamil Hmida, Department of Sports Medicine, University of Wuppertal, detected the most affected joint for patients with hemophilia and evaluated the significance of the source of pain and determined the point prevalence of back pain in Germany.

Joint Pain

Patients with hemophilia often have accompanying joint pain in the ankles, knees, and elbows. However, there have been improvements in factor therapies.

“Hemorrhages in the joints and muscles in the lower extremities (e.g. ankle joint, knee joint or musculus iliopsoas) can alter posture in the entire musculoskeletal chain,” the authors wrote. “The additional reduction in physical activity and the change in muscular load distribution due to bleeding and pain leads to muscular imbalances and a decreased range of motion in the joint.”


In the retrospective study, the investigators examined 300 patients with severe (n = 217), moderate (n = 47), and mild (n = 36) hemophilia for joint pain, the most common source of pain, and the point prevalence of back pain.

The investigators included data from 5 prospective studies collected between 2018-2021.

Each patient was given an anamnesis questionnaire and the German Pain Questionnaire.

The investigators used the results of the questionnaires to determine the most affected joint, the most frequent source of pain, point prevalence, and pain duration.

Ankle Pain

The investigators found the most affected joint in German patients with hemophilia was the ankle (41%). This was followed by the knee (27%) and the elbow (11%). In addition, the most common source of pain was the ankle joint (32%), while back pain was also identified as 1 of the most common sources of pain. This was also comparable to the elbow (elbow:15%; back:13%). There was also no significant correlation between the most affected joint and the severity of hemophilia (P >.05).

The study also shows that patients with hemophilia have higher prevalence of back pain compared to the general German population (43% vs 37%).

However, patients with mild hemophilia had a higher prevalence of back pain as well, but the investigators said it could be because of a small sample size compared to other groups.

The point prevalence in patients with hemophilia for back pain was also substantially higher compared to the general German population (P = .031).

Ultimately, the results show not much has changed in this regard in the last 20 years.

“Our data showed that the ankle is still the most affected joint and the most common source of pain in Germany,” the authors wrote. “These results also showed the relevance of back pain as a pain source. The evaluations also demonstrated the high point prevalence of back pain in [patients with hemophilia].”

The investigators also suggested future medications and therapies should focus on the spine because joint changes can impact posture.

The study, “Most subjectively affected joints in patients with haemophilia – what has changed after 20 years in Germany?,” was published online in Haemophilia.

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